Healthcare Provider Details

I. General information

NPI: 1376624734
Provider Name (Legal Business Name): HEATH A MARSHALL PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5607 CLAIBORNE RD
SUTHERLAND VA
23885-9303
US

IV. Provider business mailing address

20017 OAK RIVER DR
PETERSBURG VA
23803-5610
US

V. Phone/Fax

Practice location:
  • Phone: 804-265-5214
  • Fax: 804-265-5624
Mailing address:
  • Phone: 804-590-3033
  • Fax: 804-265-5624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202205336
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: